Transplantation: Kidney, kidney–pancreas transplant

Abstract

With in-depth understanding of transplant immunology, more sensitive assays have been developed for immunological risk assessment, crossmatch, and detection of donor-specific antibodies. The discovery of potent immunosuppressive drugs has successfully reduced the risk of acute rejection and graft loss from rejection. Kidney transplant has become the preferred therapy for treating patient with ESRD. It not only improves the quality of life but also prolongs life. Living donor kidney transplant provides better allograft and patient survival than deceased donor kidney transplant. Novel approaches of living donor exchange and desensitization protocol have been increasingly used to facilitate ABO and/or HLA incompatible kidney transplant. Pancreas transplant, either simultaneously with a deceased donor kidney or after a living donor kidney transplant, has benefited many ESRD patients with insulin-dependent diabetes. Pancreas transplant alone can also be considered for Type 1 diabetes suffering life-threatening metabolic complication despite of insulin therapy. Modern immunosuppressive protocol typically includes an initial induction therapy with T-cell depleting antibody or IL-2 receptor antibody and a long-term maintenance. Maintenance regimen usually consists of two to three drugs of steroids, calcineurin inhibitor, antimetabolite, target-of-rapamycin inhibitor, or costimulation blocker. Careful monitoring and appropriate management of surgical and medical complications are the crucial part in post-transplant patient care, especially rejection, infection, metabolic syndrome, cardiovascular disease, and malignancy.